Special Topics in Pain: Opioids

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Deep Brain Stimulation for Heroin Addiction: Possible New Treatment.

Author(s): Ciccone T G, et al.
Journal: Practical Pain Management. 2017; 17(1) 11 references.
Reprint: Thomas G. Ciccone, Staff Writer, Practical Pain Management, Montclair, NJ.
Faculty Disclosure: Abstracted by N Walea, who has nothing to disclose.
Objective: Review and evaluate the latest advances and newest information in the area of Opioids


Editor’s Note: Deep brain stimulation is becoming a treatment of interest to researchers for a variety of psychiatric conditions including addiction. The intervention is already being tested on other conditions, including cocaine addiction and obsessive compulsive disorder. Rats treated with (high frequency stimulation) HFS of the (Subthalamic nucleus) STN self-administered less heroin than those who did not receive treatment. This response points to a novel therapeutic pathway by which doctors could better treat addictive behaviors, especially considering heroin uses are at high risk of relapse after finishing rehabilitation.

Class: Technique: Deep Brain Stimulation for Heroin Addiction: Possible New Treatment.

Opioid addiction is a major public health crisis, and heroin has become a common illicit drug of choice for many Americans. Some 4.2 million persons admitted in 2011 that they had tried heroin at some point in their lives, and for about a quarter of those, their drug use evolved into an opioid use disorder.

There are clinical methods for treating heroin addiction, including forms of cognitive behavioral therapy, drug counseling and medication-assisted treatments (MAT). But, more than half of patients will relapse into heroin use within a year of their treatment and rehabilitation. There is a serious need for a better understanding of how compulsive drug behavior affects the brain.

Researchers have been studying the use of brain stimulation as a potential treatment of addiction. There are currently three types of stimulation being explored: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (TDCS) and deep brain stimulation (DBS). TMS and TDCS are noninvasive procedures that deliver a stimulus across the scalp and skull, where as DBS requires the implantation of electrodes in the brain.

Deep brain stimulation is becoming a treatment of interest for a variety of psychiatric conditions, including addiction; however, most of the research to this point has focused on just the nucleus accumbens. DBS using different parameters of stimulation has been successfully used for the treatment of compulsive behavior seen in Parkinson's disease. There are several current trials for cocaine addiction and obsessive compulsive disorder (OCD) that are targeting the same region of the brain. In a new study, researchers are applying high-frequency stimulation (HFS) to the subthalamic nucleus (STN), a section of the brain believed to be implicated in a variety of compulsive behaviors, including heroin craving.

In a study of concentric bipolar stimulation (DBS), a group of 32 rats were implanted with intravenous catheters to deliver a transfusion of heroin (0.06 mg/kg/infusion) and bilateral electrodes in the STN of the rats' brains. Approximately half of the rats (control n = 9; DBS n = 11) were trained to self-administer the heroin in stable, daily three-hour sessions, while the other half (control n = 8; DBS n = 8) self-administered heroin four times longer every day. Not surprising, the latter group showed marked escalations in self-dosing of heroin.

The rats were forced to abstain from administering heroin for two weeks and then the researchers reintroduced access to heroin. During this time, one group received HFS of the STN while the other did not. Interestingly, it was noted that, regardless if the rats were taking stable or escalating doses of the drug, stimulating the STN section of the brain appeared to make a positive difference, causing the rats to self-administer less heroin than those that had not received the treatment. The intervention, on further study, appeared dose-dependent; example, a two-day break from HFS STN treatment caused the rats to significantly increase heroin intake again. It appeared that the HFS STN treated rats were less motivated to pull the lever to self-administer heroin, which could suggest the inhibition of impulsive behaviors.

Ex vivo analysis found the intervention inhibited key parts of the brain, including the substantia nigra, the entopeduncular nucleus, and the nucleus accumbens shell. These signs point to a novel therapeutic pathway by which doctors could better treat addictive behaviors.

Important Points:
Deep brain stimulation is becoming a treatment of interest to researchers for a variety of psychiatric conditions including addiction. The intervention is already being tested on other conditions, including cocaine addiction and obsessive compulsive disorder. Rats treated with HFS of the STN self-administered less heroin than those who did not receive treatment. This response points to a novel therapeutic pathway by which doctors could better treat addictive behaviors, especially considering heroin uses are at high risk of relapse after finishing rehabilitation.

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